- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Manager , Appeals & Grievances (A&G)...cross-functional departments to appropriately address and resolve member and provider grievances . Responsible for timely daily operations… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los ... Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the...Management, Pharmacy) to appropriately address and resolve member and provider grievances . Manage staff, including, but not… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Appeals & Grievances Location: Los Angeles, CA,...Specialist II is responsible for assisting the Appeal and Grievances Compliance, Training and QA Manager to… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the...staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in… more
- Elevance Health (Walnut Creek, CA)
- …and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider , regulatory and third ... you will make an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory… more
- Elevance Health (Tampa, FL)
- …are not limited to: + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to...or any combination of education and experience, which would provide an equivalent background. + Current active unrestricted RN… more
- CVS Health (Springfield, IL)
- …with Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * ... each and every day. **Position Summary** The Medicaid Network Provider Relations Manager oversees our Medicaid ...relationship building. + Coordinate with Network Management to issue provider CAP + Monitor Grievances according NCQA… more
- Fallon Health (Worcester, MA)
- … and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative support to the department. ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and… more
- State of Colorado (Denver, CO)
- …Provide aggregate summary data as requested to the BHA Advisory Council on provider grievances , quality data, or other items as appropriate. Policy, Essential ... compliance for future value-based payment structures for safety net designated providers. . Provide routine updates on provider caseload to the Safety Net… more
- CUNY (Brooklyn, NY)
- …Rules); tracking student conduct reports; coordinating the student conduct process, grievances , and appeals . + Oversee the Faculty Student Disciplinary ... Manager of Student Advocacy and Accountability (HEA) **POSITION...intervention student support service process, the resolution of student grievances , appeals , and complaints, and the utilization… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Technical Applications Manager II Job Category: Information Technology Department: IT...public agency created by the state of California to provide health coverage to low-income Los Angeles County residents.… more
- State of Colorado (Pueblo, CO)
- Division of Facilities Management - Project Manager II - Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5048646) Apply Division of ... Facilities Management - Project Manager II - Pueblo Salary $91,320.00 - $118,728.00 Annually...to State Building policies for all CDHS projects to provide information to and advise agency administrators and other… more
- Transdev (North Las Vegas, NV)
- …and governmental laws and regulations. + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that ... Labor Relations Manager The Labor Relations Manager provides...policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Work with… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party… more
- Elevance Health (IN)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + BA/BS degree ... **LTSS Service Coordinator (Case Manager )** **Location:** Seeking candidates to work in Bartholomew...clinical healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non-clinical needs of… more
- Humana (Springfield, IL)
- … Manager , and Medical Director) and departments to address and resolve member grievances and appeals . + Oversees the interface with the Enrollment Broker ... provider referrals, self-referral services, preventive and enhanced services, and member grievances and appeals procedures + In close coordination with other… more
- Veterans Affairs, Veterans Health Administration (Brockton, MA)
- …Resolve simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the supervisor or an appropriate management ... Summary The Lead Safety and Occupational Health Manager position is in Engineering service for VA...required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade.… more
- Elevance Health (Dayton, OH)
- …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring statewide across Ohio** **Location** : This...clinical healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non-clinical needs of… more
- LA Care Health Plan (Los Angeles, CA)
- …technical aspects of the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to computer data entry, ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....nurses of a new case received from Grievance and Appeals Specialist.; submit all Grievances and … more
- Sharecare (Boston, MA)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... an exciting and innovative remote role newly created to provide meaningful support to members and their families through...payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management… more